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Save the Life-Savers

December 17, 1987

The Los Angeles County Board of Supervisors has made an emergency appropriation of $11.2 million to try to stem further deterioration of the trauma-care system. It was the right thing to do. But, as Supervisor Ed Edelman emphasized, "This is a short-term Band-Aid solution to a long-term problem." And, as the board knows, long-term problems require long-term solutions.

The trauma crisis in not unique to Los Angeles County. Supervisors in other areas of the state are facing problems in financing basic health services. Emergency rooms have had to bear an increasing share of general health care because of the inadequate state funding of the more cost-effective conventional health-care programs for people with low incomes.

If the supervisors' response has been inadequate, there is good reason for it, and the fault is by no means theirs alone. Under-funding by the state has been the single most important factor. The situation was exacerbated by Gov. George Deukmejian's veto of a $29.9-million trauma-center bail-out bill last summer. He argued that trauma care is strictly county business.

It is not strictly county business so long as the state fails to do its share of funding. The trauma centers cannot be separated from the rest of the public-health system under these circumstances. Hospitals are dropping out of the trauma network because they cannot afford the increased caseload of uncompensated care that is generated by the trauma centers. Hospitals can't afford it because of the inadequacy of the state's Medi-Cal coverage and fees and the inadequacy of state support for the care of the medically indigent.

In Los Angeles County, state funding this year for the medically indigent is $204 million, compared with the $281 million that the county calculates as appropriate. Furthermore, state grants to compensate for county property-tax losses under Proposition 13 have fallen behind increases justified by the cost of living so that this year's $172 million is $31 million less than it would have been had the state kept pace with inflation. Los Angeles and Alameda counties are challenging the state funding for indigent health care in the courts just as a public lawsuit is challenging the funding for Medi-Cal statewide.

The Hospital Council of Southern California, while welcoming the $11.2-million emergency appropriation voted Tuesday, estimates that the real need was for $16 million over the next six months. Without that money, there is a risk that hospitals will be unable to find physicians who are able to afford service in the trauma centers. Almost half the patients are indigents who are unable to pay the doctors themselves.

Trauma centers are essential to everyone. There is no way to anticipate when or where their life-saving services will be needed. Los Angeles County has already lost five of the centers, the state nine. Each of those trauma-center closures means an increased health risk to anyone suffering critical illness or accidental injury.

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